IV Therapy Initiation
Applicable Providers: ACP, LPN, PCP, RN, RPN
Indications
- Treatment of dehydration
- Need for medications via IV route
- Life-threatening illness/injury (anaphylaxis, cardiac arrest, shock, seizures)
- Significant mechanism of injury (fall >10 ft with HR >120, hypotension)
Contraindications & Cautions
| Condition | Status |
|---|---|
| None | No absolute contraindications |
| CHF (congestive heart failure) | Caution - avoid fluid overload |
| Suspected hyponatremia | Caution |
| Elective hydration for VIP care | Relative - CDM discretion |
Initiating IV Therapy
SFA, FR, EMR: Call for assistance. Protect IV line from being pulled out during moves
PCP, LPN, RPN, RN, ACP:
- Prepare (prime) all equipment - ensure no air in tubing
- Normal saline is fluid of choice unless otherwise indicated
- D10W may be given per hypoglycemia policy
- Do NOT initiate hypertonic (3%) saline without specific MD order
- Consider 250cc bolus (if no CHF/hyponatremia), then reassess (VS, LOC)
- Observe for fluid overload signs/symptoms
Troubleshooting
| Problem | Solution |
|---|---|
| Infiltration (sluggish/stopped, swelling, redness) | Discontinue IV |
| Fluid overload (SOB, crackles, orthopnea) | Reduce to 50cc/h, refer to higher care |
| Infection (redness, pain, swelling) | Monitor, discontinue and re-site as needed |
| "Speed shock" | Give IV meds per protocol (some must go slow) |
| Air embolism | Ensure tubing fully primed, secure connections |
Documentation
- Clinical indication for IV
- Size of IV catheter
- Site of insertion/re-site (and unsuccessful attempts)
- Type of IV fluid
- Volume hung
- Rate of infusion per hour
- Provider signature and designation
⚠️ Safety: Dispose of sharps in appropriate container. Use universal precautions to avoid needle stick injuries.
Source: Odyssey Medical Consulting
Version: 2023-06-21